Provider Demographics
NPI:1003110651
Name:WATSON, KIMBERLY R
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:R
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 NW 63RD ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7907
Mailing Address - Country:US
Mailing Address - Phone:405-418-3858
Mailing Address - Fax:
Practice Address - Street 1:301 NW 63RD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7907
Practice Address - Country:US
Practice Address - Phone:405-418-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management